Chronic Subdural Haematoma

Chronic subdural haematoma(CSDH) is a neurological condition, which is more common among the elderly. Learn more about the condition, its symptoms, treatment and more.

What is Chronic Subdural Haematoma?

CSDH is a neurological condition that refers to a collection of blood and blood breakdown products between the surface of the brain and its outermost covering (dura). It is common among elderly patients and chronic alcoholics, and may be caused by a minor or major  head injury.

To continue reading about the symptoms and treatment for chronic subdural haematoma, please click here. 

Chronic Subdural Haematoma — Symptoms

Symptoms of this condition include:
confusion or coma
difficulty in speaking or swallowing
difficulty in walking
weakness or numbness of arms, legs or face

Chronic Subdural Haematoma — Causes and Risk Factors

What causes CSDH?
Small veins called “bridging veins” run between the dura and the surface of the brain. A subdural haematoma develops when these veins tear and leak blood, usually as the result of a head injury. When this happens, a collection of blood forms over the surface of the brain. Membranes then start developing around the blood clot which slowly liquefies. Repeated small bleeds from the membranes cause it to grow in size after several weeks. As a result, the problem is usually not discovered immediately. Instead, its presence becomes known only weeks after the initial injury. 

CSDH can develop on one or both sides of the brain.

Risk Factors
Trauma to the brain from a head injury is the most common cause of CSDH. The elderly and chronic alcoholics are more at risk mainly because of brain and vein shrinkage due to age or alcohol abuse. When the head is accidentally hit, even during a minor head injury, the bridging veins are stretched even more, making the person more liable to suffer from CSDH.

In rare cases, a subdural haematoma can occur spontaneously without there being an accident or injury. 

People who have used blood thinning medications such as aspirin or who have diseases associated with blood clotting problems are also at risk of developing CSDH. 

Diagnosing Chronic Subdural Haematoma

CSDH is diagnosed by:
a physical examination that includes a full neurological work-up to test your mental functions, strength, reaction to sensations, coordination, walking and balance.
a head computerised tomography (CT) or magnetic resonance imaging (MRI) scan may be done for further evaluation.

Chronic Subdural Haematoma: Treatment

Is surgery necessary?
Unfortunately, few chronic subdural haematomas heal themselves over time. They often require surgery, particularly in the case of significant brain compression, neurological problems, seizures or chronic headaches. 

Since the blood is in a liquefied state, surgery is usually carried out by drilling two small holes, known as burrholes, in the skull to allow blood to drain away. Solid blood clots may need to be removed through a larger opening (craniotomy) in the skull. One or two drains are usually placed to drain blood and fluid from the operation site.

Post-surgery, the patient will be transferred back to the ward for monitoring and nursed flat in bed during the immediate post-operative period to allow the brain to re-expand. On the second day after the operation, the drain will be removed and the patient will be able to sit up in bed and encouraged to walk around if possible. 

What is the long-term outcome after surgery?
Some chronic subdural haematomas may return after surgery, in which case, surgery will most likely be needed again.

Post operation, most patients can be discharged after five-seven days. He/she will eventually be able to resume normal activities. However those with significant preoperative disabilities may need to undergo a period of rehabilitation.
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